Limitations of a quantitative swollen and tender joint count to assess and monitor patients with rheumatoid arthritis.
A quantitative count of swollen and tender joints is a primary measure to assess patients with rheumatoid arthritis (RA), and is weighted of higher value than the other 5 Core Data Set measures in all indices in which it is included. However a number of limitations of the swollen and tender joint count have been described in the rheumatology literature, including poor reproducibility, with a requirement to be performed by the same observer at each visit; likelihood to improve with placebo treatment as much or more than the other 5 RA Core Data Set measures in clinical trials; similar or lower relative efficiencies than global and patient measures to document differences between active and control treatments in clinical trials; improvement over 5 years in clinical care, while joint damage and functional disability may progress; and lower sensitivity to detect inflammatory activity than ultrasound. Most visits to a rheumatologist do not include a formal quantitative joint count. It may be suggested that a careful qualitative joint count, supplemented by quantitative patient self-report questionnaire scores, may be more than adequate to monitor and document changes in patient status in busy clinical settings.
Pincus
Theodore
T
New York University School of Medicine, New York, NY, USA. tedpincus@gmail.com
D001172:Arthritis, Rheumatoid / Q000150:complications / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D002986:Clinical Trials as Topic; D004185:Disability Evaluation; D018450:Disease Progression; D006801:Humans; D007596:Joints / Q000473:pathology* / Q000503:physiopathology; D015588:Observer Variation; D010146:Pain / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D010147:Pain Measurement; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome